J&J, Distributors Strike Landmark $26B Opioid Deal | Health

By GEOFF MULVIHILL – Associated Press

CAMDEN, NJ (AP) — Drugmaker Johnson & Johnson and three major distributors on Friday finalized statewide agreements about their role in the opioid addiction crisis, an announcement that paves the way for $26 billion to be sent to almost every state and locality flow in the US

Taken together, the settlements are the largest yet among the many opioid-related cases that have unfolded across the country. They are expected to provide a significant boost to efforts aimed at reversing the crisis in places it has devastated, including many parts of rural America.

Johnson & Johnson, AmerisourceBergen, Cardinal Health and McKesson announced the settlement plan last year, but the deal was dependent on the involvement of a critical mass of state and local governments.

Friday was the deadline for companies to say whether they felt enough governments had committed to participate in the settlement and waived their right to sue. The four companies notified governments’ lawyers if their thresholds were met, meaning money could flow to communities from April.

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“We will never have enough money to solve this problem immediately,” said Joe Rice, one of the lead attorneys representing local governments in the litigation that led to the settlement. “What we’re trying to do is give a lot of small communities the opportunity to try to change some of their problems.”

While none of the settlement funds will go directly to victims of opioid addiction or their bereaved families, the vast majority of it must be used to fight the epidemic. The need for funding runs deep.

Kathleen Noonan, CEO of the Camden Coalition of Healthcare Providers, said part of the settlement money should be used to provide housing for people with addiction who are homeless.

“We have clients who have a hard time staying clean to make it at an animal shelter,” she said. “We want to stabilize them so we can help them recover.”

Camden County government spokesman Dan Keashen said officials are considering using settlement funds for a public education campaign to warn of the dangers of fentanyl. They also want to send more drug counselors onto the streets, add more social workers to the district courts, and pay for anti-narcotics drugs in the county jail.

Officials across the country are considering pumping the money into similar priorities.

California Gov. Gavin Newsom’s proposed budget sees using $50 million of the state’s expected $86 million share this year to educate youth about opioids and educate treatment providers, improve data collection and the distribution of naloxone, a drug that reverses overdoses.

In Florida’s Broward County, home of Fort Lauderdale, the number of beds at a county-run detoxification facility could expand from 50 to 70 or 75, said Danielle Wang French, a county attorney.

“It’s not enough, but it’s a good start,” she said of the comparison.

As deadly overdoses continue to rage in the US, largely because of the proliferation of fentanyl and other illicitly manufactured synthetic opioids, public health experts are urging governments to use the money to ensure access to drug treatment for people struggling with addiction. They also emphasize the need to fund programs that are proven to work, collect data on their efforts, and launch prevention efforts for young people while also focusing on racial justice.

“It shouldn’t be done, spend,” said Joshua Sharfstein, a former secretary of the Maryland Department of Health and Human Services who is now the vice dean of public health at Johns Hopkins University. “It should be: think, strategize, spend.”

In a separate deal, also included in the $26 billion, the four companies reached a $590 million settlement with the nation’s federally recognized Native American tribes. About $2 billion will be set aside for fees and expenses for the attorneys who worked on the case for years.

Johnson & Johnson, based in New Brunswick, New Jersey, has nine years to pay off its $5 billion stake. The Distributors – AmerisourceBergen of Conshohocken, Pennsylvania; Cardinal Health of Columbus, Ohio; and McKesson of Irving, Texas — agreed to pay their combined $21 billion over 18 years. To reach the maximum amounts, states must get local governments to sign up.

The settlements go beyond money. J&J, which has stopped selling prescription opioids, agrees not to resume operations. The dealers agree to send data to a clearinghouse to help detect when prescription drugs are being diverted to the black market.

The companies admit no wrongdoing and continue to defend themselves against claims that they helped cause the opioid crisis, made by companies not involved in the settlements.

The call for most of the money to be used to deal with the opioid crisis contrasts with a series of public health settlements with tobacco companies in the 1990s. In these cases, states used large parts of the settlement money to fill budget gaps and fund other priorities.

The amount sent to each state under the opioid agreement depends on a formula that takes into account the severity of the crisis and the population. Districts and municipalities also receive a share of the money. A handful of states — Alabama, New Hampshire, Oklahoma, Washington, and West Virginia — have not joined the accord in whole or in part, largely because they have their own accords or are preparing for a process.

In Camden this week, Lisa Davey, a recovery specialist for the Maryville Addiction Treatment Center, was at a needle exchange to distribute naloxone, a drug that reverses overdoses, and asked people if they wanted to start treatment.

Davey said she wants detox and treatment programs to get more funding to keep people in them longer. As it is, she said, users can detox and hit the streets again in a matter of days in search of drugs.

“They need more time to work on their recovery,” she said.

A man who picked up clean needles and asked to be identified only as Anthony P. said he was 46 and had struggled with addiction since he was young. He said he would like to see efforts to phase out fentanyl and related synthetic opioids, which are driving up overdose mortality rates, from the drug supply.

“Fentanyl has to go,” he said.

Martha Chavis, president and CEO of the Camden Area Health Education Center, which runs needle exchanges, said there is a need to offer services like hers in more places. Now consumers travel to Camden from far-flung suburbs to get clean needles and kits to test their medication for fentanyl.

The settlement with J&J and the three distributors is an important step in resolving the vast constellation of US lawsuits over liability for an epidemic linked to the deaths of more than 500,000 Americans over the past two decades.

Other companies, including management consultant McKinsey and drugmakers Endo, Mallinckrodt and Teva, have reached national or a range of local settlements. OxyContin maker Purdue Pharma and a group of states are mediating in the US bankruptcy court to try to reach a statewide settlement.

The crisis has intensified during the coronavirus pandemic, with US opioid-related deaths peaking at more than 76,000 in the 12 months to April 2021, largely due to the proliferation of fentanyl and other laboratory-made drugs. A recent report by a commission from the medical journal The Lancet predicts that without policy changes, 1.2 million Americans could die from an opioid overdose between 2020 and 2029.

John F. Kelly, a professor of psychiatry in addiction medicine at Harvard Medical School, said he wants to see the money from the settlements being used not only for treatment, recovery and support efforts, but also for building systems that help the occurrence to prevent this kind of epidemic again.

“Some sort of national board or organization could be set up … to prevent that kind of lack of oversight from happening again – where the industry is allowed to create a public health hazard,” he said.

That story was corrected by Johnson & Johnson saying it had nine years to pay its share of the settlement, not ten.

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